All of the commonly used frameworks have similarities in their basic organization and utility for a variety of purposes.  A model developed at the World Health Organization took a broader approach to include macro driving forces in the pressures on health and the environment.  The model was called the “Driving Forces-Pressures-State-Exposure-Effects-Action (DPSEEA) framework”.   The DPSEAA model (Figure 2) is useful as it covers the full spectrum of potential forces and resulting actions and brings together professionals, practitioners, and managers from both environmental and public health fields to help orient them in the larger scheme of the problem.  The DPSEEA model has been adopted by the Ciudad Juarez Workshop in June, 2000.. 

 

 
Figure 2.The Driving Forces, Pressure, State, Exposure, Effect, Action (DPSEEA) model of WHO (WHO, 1999:5)

These frameworks have been developed to serve the purpose of emphasizing the level of specificity or desired focus of a specific monitoring program, and thus the adaptation of the framework is dictated by the goals and objectives of the monitoring exercise.  Whether the interest of the monitoring program is to look at the factors involved in greater detail leading to the pressures on a system (what Corvalan et al. (1996) and von Schrinding (2000) call “driving forces”), at the states or responses within the system (e.g. external dose, internal dose and effect at the organism, cellular or molecular level), or at actions taken to combat negative impacts (e.g. government emission control legislation) is determined by the program goals and its ultimate purpose.  Therefore, depending upon the differences in the focus of two hypothetical programs, what one program defines as a “hazard”, may refer to another program’s “external dose”, or what one program terms a “pressure”, another may define as a “state”.